Study design, materials and methods
134 men 22-50 years old with CPPS were examined by: visual analogue scale of pain (VAS); IPSS; QoL; International Index of Erectile Function (IIEF), NIH-CPSI questionnaires; ultrasound, urodynamic and neurophysiological studies. On the base of these results patients were divided into 4 subgroups:
I - predominant voiding dysfunction (n = 52);
II - significant erectile dysfunction (n = 39);
III - predominance of pain with neurophysiological changes (n = 31);
IV - pain without identified neurophysiological pathology (n = 12).
VAS results show that expression of pain in groups I and II was slightly lower than in III and IV. Differences were significant only between I-IV and II-III groups. According to NIH-CPSI the most severe symptoms were observed in groups I, II and IV with statistically obvious differences between all groups, except I-IV pair. LUTS and QoL fall were most pronounced in groups I and II. Erectile dysfunction was significantly higher in group II as it was.
More significant disturbance of uroflowmetry and urethral profilometry data were identified in group I. Groups I-III had significant deviation in bulbocavernosus reflex latencies. Patients of group IV did not exceed the physiological norm. Similar pattern was found in conduction veloci-ty of the dorsal nerve of the penis (Tab. 1).Patients received a differentiated therapy depending on the predominant symptoms: voiding or erectile dysfunction or pain. Effectiveness was assessed 3-4 weeks after the start of treatment.
Group I patients were treated by botulinum toxin type A (BTXA) which was injected into the bladder sphincter or sphincter and detrusor depending on the identified type of abuse. Statistical-ly significant results were achieved for all parameters.
Group II received sildenafil (50 mg/day). Obvious improvement was also noted in most indices. Groups III and IV were treated by baclofenum (60 mg/day) - a muscle relaxant of central action. We did not observe any credible effect in group IV in most settings.
Interpretation of results
Distribution of patients into subgroups depending on the predominant clinical symptom/disorder allows us to recommend them more rational and reasonable therapy. Understanding and detailing the mechanisms causing disorders is a key to successful treatment.